Mental health counseling preferences amongst adolescents living with HIV, caregivers, and healthcare providers in Lilongwe, Malawi

In Malawi, there is a need for resource-appropriate interventions that improve depression among adolescents living with HIV (ALWH) that incorporate their service delivery preferences. To understand these preferences, we thematically analyzed qualitative data from a formative study adapting an evidence-based depression intervention for ALWH in Malawi. Participants (N = 42) included ALWH experiencing depression (age 13-19, BDI-II ⩾ 13), caregivers, healthcare providers, implementors, and participants of a similar counseling intervention. Findings revealed a preference for private, clinic-based individual counseling to maintain confidentiality and avoid stigma. While desired frequency for sessions varied, participants consistently wanted young (<40), mature, trustworthy, and non-judgmental counselors. Counseling sessions should address the relationship between HIV and depression and the socioeconomic stressors resulting from living with chronic, stigmatized diseases. Results emphasize the importance of confidentiality, flexibility, and choice when providing mental health services for ALWH, and the need to train lay counselors to navigate discussions around socioeconomic stressors.